Pectoral Nerve Block for Cardiac Device Implants: A Systematic Review and Meta-Analysis

Area of Science:

• Anesthesiology
• Pain Management
• Cardiology

Background:

• Cardiac implantable electronic device (CIED) procedures often cause significant peri- and post-operative pain.
• The Pectoral Nerve Block (PECS), originally for breast surgery, is increasingly adopted for chest surgeries, including CIED implantation, to manage pain.
• Limited data exists on the efficacy and safety of PECS blocks for CIED pain management.

Purpose of the Study:

• To systematically review and meta-analyze the available evidence on the efficacy and safety of the PECS block for pain management in patients undergoing CIED implantation.
• To estimate the impact of PECS blocks on pain scores and opioid requirements post-CIED surgery.

Main Methods:

• A comprehensive search of Medline (PubMed) and Scopus databases was conducted up to May 31, 2025.
• Included studies were randomized controlled trials and observational studies reporting on PECS block use for CIED pain control.
• Five eligible studies (n=816) were included in the meta-analysis (PROSPERO CRD420251071794).

Main Results:

• The meta-analysis revealed low mean pain scores at 1, 6, and 24 hours post-CIED implant (1.74±0.65, 0.98±0.12, 1.06±0.93).
• One study showed significantly lower pain scores with PECS compared to standard care at 4 hours (1.5±2.1 vs. 4.5±2.5, p<0.001).
• PECS blocks were associated with reduced intra- and post-operative opioid requirements (12.17% and 9.95% respectively), with no reported complications.

Conclusions:

• Observational data suggests PECS blocks are effective for pain control after CIED implantation, leading to lower pain scores and reduced opioid use.
• High patient satisfaction is indicated with PECS block use in this context.
• The current evidence base is limited by a lack of robust comparative and randomized data, necessitating further research.